Type 1 and Type 2 – By Liz Buchanan
‘Oh! You’re a real diabetic, then!’
‘A real diabetic?’
As opposed to what, faking it for conversational purposes?
‘Not one of these – you know, these type two people.’
Ah! Type 2 or – as one of my Type 2 friends calls it – “Class Two” diabetes. At first I thought this was an overreaction on the friend’s part but the longer I am diabetic the more I hear it. Type One – ‘proper, serious, bad, dangerous, difficult’ diabetes. Type Two: ‘not serious’ or even ‘their own fault.’
There was a Facebook reply to my last blog-post to the effect: ‘Who do I talk to about my diabetes? No-one. People aren’t bothered because I’m a type 2’. It made me angry on behalf of the person who had written it (although I’d like to point out that diabetessupport.co.uk is a message board full of people who care passionately about and want to discuss type 2 – and type 1 – diabetes).
So let’s clear all this up. What is the difference?
Well first let’s look at what’s the same. ‘Diabetes’ means that for whatever reason your body cells are not taking enough glucose out of the blood. This means that the glucose builds up in the bloodstream. Over time, high blood glucose can lead to neuropathy (which is often associated with amputated feet or legs), retinopathy (associated, in extremis, with blindness) and nephropathy (that is, irreversible kidney damage).
Does any of that sound ‘not serious’ to you?
‘Type One’ and ‘Type Two’ diabetes were names that some creative spark invented when it was realised that ‘Juvenile-Onset’ (now Type-One) diabetes doesn’t just occur in juveniles: I was twenty-six when I was diagnosed and this is hardly considered to be old these days. People are occasionally diagnosed in their eighties.
So what is Type One? – It is an ‘autoimmune’ disease, meaning that our immune system turns against our own pancreatic cells and prevents them from making insulin. Insulin ‘tells’ our cells to take glucose out of the blood: if we don’t make it, the cells don’t take it. What causes this? Genetics; possibly a viral trigger. What doesn’t cause it? – there is no direct link between Type One and sugar consumption.
Type Two diabetes can also come on at any age: once dubbed ‘mature onset diabetes’ it is becoming increasingly common in youngsters too. Either the body cells become ‘resistant to’ (i.e. start to ignore) insulin, or less insulin is made, or both. What doesn’t cause it? – there is no direct link between Type Two and sugar consumption. Obesity is thought to be a strong risk-factor; there is also a genetic component. Nobody gets diabetes just ‘because they are fat’. There are plenty of very, very fat people who will never get type two diabetes even if they live on fizzy drinks. There are also plenty of type two diabetics who have never been overweight.
However the link between Type Two and lifestyle factors is strong enough that a change in diet and increase in exercise can often bring it under control. So while newly-diagnosed Type Ones go home with a set of Insulin-pens to start injecting, many newly-diagnosed Type Twos follow a new eating plan and exercise. Anyone who has ever tried to completely and forever overhaul their lifestyle will realise that this is a colossal challenge, particularly when you are ill: to presume that one group require support and the other don’t is purely and simply wrong.
If diet and exercise changes do not do the trick, Type 2s often take tablets to lower their blood glucose or carb-count and inject insulin, just like a Type One. Going back to the lady on the tram, I wonder whether she would consider them ‘real’ diabetics now?